The topic of this thesis is discussion of usage of myofunctional therapy on persons with communicative disorders. The main goal is to map the extent and possibilities of this therapy in speech therapy practice. The theoretical part deals with physiology and patophysiology of breathing, sucking, swallowing and the orofacial system. Further, in connection with myofunctional therapy it discusses its historical development, methodical approaches, utilities, therapeutical benefits and possibilities of education on this field. The empirical part contains a quantitative investigation, which analyses the extent and usage possibilities of this therapy by speech-language pathologists in the Czech Republic. Based on the data obtained by a questionnaire distributed to speech-language pathologists it can be stated, that about 20 % of the respondents do not use the myofunctional therapy in practice, while those (with one exception) never took part on an expert training. The offer of the trainings is rated as insufficient. The myofunctional therapy can be used on persons with orofacial disorders regardless of age or communicative disorder. KEYWORDS: myofunctional therapy, communicative disorder, swallowing, dysphagia, bite disorders, orofacial area

Objective: This study sought to determine the factor structure of the newly developed self-report screening questionnaire Eating Disturbances in Youth-Questionnaire (EDY-Q) as well as to report the distribution of variants of early-onset restrictive eating disturbances characteristic of avoidant/restrictive food intake disorder (ARFID) in a middle childhood population sample. Method: Using the EDY-Q, a total of 1444 children aged 8-13 years were screened in elementary schools in Switzerland via self-report. The factor analysis of the 12 items covering ARFID related symptoms was performed using a principal component analysis (PCA). Results: The PCA showed a four factor solution, with clear allocation to the scales covering three variants of early-onset restrictive eating disturbances and weight problems. Inadequate overall food intake was reported by 19.3% of the children, a limited accepted amount of food by 26.1%, and food avoidance based on a specific underlying fear by 5.0%. Discussion: The postulated factor structure of the EDY-Q was confirmed, further supporting the existence of distinct variants of early-onset restrictive eating disturbances. Avoidant/restrictive eating behavior seems to be a common experience in middle childhood, but results have to be confirmed using validated interviews.

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-08-10T12:08:37Z No. of bitstreams: 1 ANA CLÁUDIA MAGALHÃES MATOS.pdf: 3267899 bytes, checksum: 2d2b25e1956255ea5beaaf63fb6ba19e (MD5) / Made available in DSpace on 2017-08-10T12:08:37Z (GMT). No. of bitstreams: 1 ANA CLÁUDIA MAGALHÃES MATOS.pdf: 3267899 bytes, checksum: 2d2b25e1956255ea5beaaf63fb6ba19e (MD5) Previous issue date: 2017-03-10 / Oropharyngeal dysphagia is a common disorder in people that survived a cerebrovascular accident (CVA). It is a disability that contributes to the lack of functionality and dependency to eat. These eating limitations lead to clinical risks and adaptation needs to deal with the restrictions. The objective of the present dissertation, a qualitative case study, was to describe the experience of living with oropharyngeal dysphagia after a CVA from the patients‟ and their relative caregivers‟ perspectives. The dissertation reports seven cases of people who survived a CVA; these patients live in the southwest of Bahia and were discharged from hospital presenting signs and symptoms of dysphagia between October 2015 and July 2016. Data were collected through semi-structured interviews at the patients‟ homes. Five patients and seven relative caregivers were interviewed individually or in pairs. By applying an interpretative thematic analysis, the following thematic topics were identified: changes in preparing, handling and offering food; difficulties and feelings of the patients and relative caregivers before dysphagia; and social support. Confrontation of the signs and symptoms of dysphagia occurred with little orientation, mainly in the transition from hospital to home care, and little formal support. It was observed that the signs and symptoms of this disorder, such as cough and choking, are frequent, especially during the postdischarge period, and cause dissatisfaction and reveal a lack of preparation to deal with difficulties. The relative caregivers that did not receive orientations and help to manage the eating routine of the patients faced a greater difficulty to prepare, handle and offer food. The results show the importance of interdisciplinary team work, mainly to prepare the family for hospital discharge, and the relatives‟ commitment in the care process regarding the application of educational practices and training to achieve humanized care and a higher quality of life for patients. In addition to these measures, the findings confirm the need for speech therapy interventions focused on the evaluation of patients with CVA and follow-up of their eating patterns throughout the rehabilitation process. / A disfagia orofaríngea é um distúrbio observado frequentemente em pessoas que sobrevivem ao acidente vascular cerebral (AVC). Trata-se de uma incapacidade que contribui para a perda da funcionalidade e da independência para se alimentar. As limitações para a alimentação levam a riscos clínicos e necessidades de adaptação para enfrentar as dificuldades existentes. O objetivo desta pesquisa, do tipo estudo de caso qualitativo, foi descrever a experiência de vivenciar a disfagia orofaríngea após o acidente vascular cerebral na perspectiva do paciente e de cuidadores familiares. Foram descritos os casos de sete sobreviventes ao AVC, residentes em um município do Sudoeste da Bahia e que receberam alta hospitalar com sinais e sintomas de disfagia, no período de outubro de 2015 a julho de 2016. Os dados foram coletados por meio de entrevistas semiestruturadas realizadas em domicílio. Foram entrevistados cinco pacientes e sete cuidadores familiares, de modo individual, ou em díades. Por meio da análise temática interpretativa, foram identificados os seguintes núcleos temáticos: mudanças no preparo, manejo e oferta da dieta; dificuldades e sentimentos dos pacientes e cuidadores familiares no enfrentamento da disfagia e o apoio social. O enfrentamento dos sinais e sintomas da disfagia ocorreu com poucas orientações, principalmente no processo de transição do cuidado hospitalar para o domicílio, e pouco apoio formal. Observou-se que os sinais e sintomas deste distúrbio como tosse e engasgos são frequentes, sobretudo na fase pós alta hospitalar, e trazem sentimentos de insatisfação, bem como demonstram o despreparo dos cuidadores para lidar com as dificuldades. Os cuidadores familiares que não tiveram orientações e auxílios nas condutas durante alimentação se depararam com maior dificuldade no preparo, manejo e oferta da dieta. Os resultados evidenciam, além da necessidade de intervenções fonoaudiológicas focadas na avaliação do paciente com AVC e no acompanhamento de seu padrão de alimentação no decorrer do processo de reabilitação, a importância da atuação de equipes interdisciplinares, principalmente no preparo para alta hospitalar, e do envolvimento da família no processo do cuidar, com vistas ao desenvolvimento de ações educativas e treinamento prático para a busca constante da humanização e melhor qualidade de vida.

Made available in DSpace on 2016-04-27T18:12:19Z (GMT). No. of bitstreams: 1 LUANA ALMEIDA MAGALHAES.pdf: 416185 bytes, checksum: 2da39944683577080e3ca1273a8fc232 (MD5) Previous issue date: 2007-02-28 / This study deals with the description of a home care dysphagic patient case study. The aim was to demonstrate the relevance of the psychic aspects in the swallowing disorders treatment, searching to understand why the dysphagic symptoms became recurrent since in the organic-functionary point of view, the patient had no more disorders. This is a descriptive research done through clinic-qualitative method, by a unique, exemplary or emblematic clinical case study of an 82 years old patient (named as Dona Laura) with stroke that caused dysphagia, paresthesia and paresis of the left facial side, beyond language expression disorder and dysarthria. The data had been collected between June 2004 and December 2005, and the clinical material consisted of the therapies memories analysis, made by weekly registers, written in a narrative form. The stroke brought fragility to the patient subjectivity and made it difficult to her support the familiar relations, as well as her routines. The opening of the therapist listening to this suffering situation allowed the patient to be dislocated from the organic rehabilitation into the direction of a ressubjectivation, meaning a construction of a new subjective profile, more satisfactory in the current relationary conditions of patient s life. The research demonstrated the relevance of considering the body in the dysphagia treatment, not only on its organic face, but also on its symbolical and affective spheres / A dissertação trata da descrição de um caso clínico de paciente disfágica atendida em domicílio. O objetivo foi demonstrar a relevância dos aspectos psíquicos na reabilitação fonoaudiológica dos transtornos de deglutição, buscando entender por que os sintomas disfágicos se tornaram recorrentes mesmo que, do ponto de vista orgânico-funcional, a paciente não mais possuísse alteração alimentar. Trata-se de uma pesquisa descritiva, realizada a partir do método clínico-qualitativo, por meio de estudo de caso clínico único, exemplar ou emblemático. O caso clínico relatado nesta pesquisa é de uma paciente de 82 anos (nomeada como Dona Laura), que foi acometida por um Acidente Vascular Encefálico Isquêmico e apresentava quadro de disfagia e de parestesia e paresia facial à esquerda, além de alteração na expressão da linguagem e disartrofonia. Os dados para reflexão foram coletados no período de junho de 2004 a dezembro de 2005, e o material clínico constituiu-se da análise das memórias dos atendimentos e dos registros semanais, escritos em forma de narrativa após os atendimentos realizados. O advento do AVE fragilizou subjetivamente a paciente e isso dificultou tanto as relações familiares quanto suas rotinas. A abertura da escuta da terapeuta para as angústias advindas desta situação permitiu que a paciente pudesse se deslocar a partir da reabilitação orgânica em direção à uma ressubjetivação, ou seja, à construção de um novo perfil subjetivo, mais satisfatório em relação às condições atuais de vida e relacionais da paciente. A pesquisa demonstrou a relevância de se considerar o corpo na reabilitação fonoaudiológica das disfagias, não apenas por sua face orgânica, mas nas esferas simbólica e afetiva

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Comparar e caracterizar, por intermédio dos protocolos de avaliação da deglutição, os achados fonoaudiológicos na fase preparatória oral e oral da deglutição nos pacientes avaliados nos dois grupos de doenças (DM/PM e ES). Foram identificados 80 pacientes com diagnóstico de dermatopolimiosite e esclerose sistêmica, de ambos os sexos, atendidos no ambulatório de Colagenoses do serviço de Reumatologia do Hospital Universitário Pedro Ernesto (HUPE-UERJ). Foram excluídos os indivíduos abaixo de 18 anos e acima de 60 anos (24) e com outras doenças e/ ou comorbidades. Dos 56 pacientes restantes, 73,2% (41) apresentavam ES e 26,8% (15) DM/PM. Após a assinatura do termo de consentimento livre e esclarecido, os indivíduos foram submetidos à avaliação clínica estrutural e funcional da deglutição pelo pesquisador, que é fonoaudiólogo. O estudo revelou elevada prevalência de alterações oromiofuncionais e da deglutição na fase preparatória oral e oral propriamente dita nos pacientes com ES para a consistência sólida, que geram disfagia oral e alta, e não somente uma disfagia baixa como tem sido apresentado na literatura médica. O estudo reforçou que as mulheres são as mais acometidas pelas doenças autoimunes e que os homens são em menor número. O fonoaudiólogo deve ser parte integrante da equipe interdisciplinar que atende esses pacientes. / Compare and Characterize by means of evaluation protocols of swallowing, speech-language findings in oral and oral preparatory phase of swallowing in patients evaluated in both groups of diseases (DM / PM and SS). We identified 80 patients with dermatomyositis and systemic sclerosis, of both sexes, Collagen outpatient clinic of the Rheumatology Service of Hospital Universitário Pedro Ernesto (HUPE-UERJ). We excluded individuals below 18 years and above 60 years (24) and other diseases and / or comorbidities. Of the 56 remaining patients, 73.2% (41) had SS and 26.8% (15) DM / PM. After signing an informed consent, subjects underwent structural and functional clinical assessment of swallowing, the researcher who is a speech and audiologist therapist. The study revealed high prevalence of oromiofunctionals and oral phase swallowing in patients with SS to solid food dysphagia and oral generating not only a high and low dysphagia as has been shown in medical literature. The study reinforced that women are more affected by autoimmune diseases, and that men are fewer. The speech and audiology therapist must be part of the interdisciplinary team that deals with these patients

Introdução: Medir e melhorar a qualidade dos serviços de saúde é um importante e atual desafio. O uso de instrumentos de controle como painel de indicadores ou balanced scorecard (BSC) tem crescido no setor da saúde. Esta dissertação teve como objetivo a proposição de um painel de indicadores de desempenho para a gestão de um Serviço de Fonoaudiologia em Unidades de Internação (enfermaria, unidades de terapia semi-intensiva e intensiva). Método: Quatro fases foram estabelecidas para a elaboração do painel: identificação de processos a serem gerenciados; elaboração dos indicadores e padronização de obtenção dos dados; classificação e proposição de correlação dos indicadores; elaboração do painel de indicadores. Resultados: Foram propostos doze indicadores correlacionados em cadeia de causa e efeito: Índice de Avaliação da Deglutição; Índice de Atendimento por Paciente; Índice de Atendimento por Fonoaudiólogo; Índice de Pacientes Atendidos; Taxa de Gravidade; Taxa de Avaliação por Unidade de Internação Hospitalar; Índice de Demanda para Reabilitação da Deglutição; Tempo para Avaliação da Deglutição; Índice de Fonoaudiólogo por Leito; Tempo para Retirada da Via Alternativa de Alimentação; Tempo para o Retorno da Alimentação por Via Oral; Tempo para Decanulação. Conclusão: O painel de indicadores proposto favorece o gerenciamento da reabilitação da deglutição em ambiente hospitalar. A implementação deste instrumento permite a análise do desempenho do serviço ao longo do tempo, frente a inclusão de novos processos ou tecnologias e, a comparação a outros serviços julgados como referências no setor. O processo de medição de indicadores é essencial para o gerenciamento da qualidade. O gerenciamento por indicadores corrobora ainda para que a eficácia e eficiência dos programas de reabilitação da deglutição sejam evidenciadas / Background: Measuring and improving the quality of health services is an important and ongoing challenge. The implementation of control tools such as panel of indicators and balanced scorecard (BSC) has grown in the health sector management. This dissertation proposes a panel of indicators for the management of Speech and Language services at Hospital Units. Method: Four stages were established for the panel of indicators design: identifying procedures to be managed, generating indicators and standardizing data collection, identifying the correlation among indicators, and formulating the panel of indicators. Results: Twelve performance indicators were proposed. These were correlated in a cause and effect chain: Swallowing Evaluation Index, the Individual Care Index, The Speech Language Pathologist (SLP) Care Index, the Number of Assisted Patients Index, the Severity Rate, the Swallowing Diagnosis Rate per Hospital Unit, the Swallowing Rehabilitation Demand Index, the Time until First Swallowing Evaluation; the SLP Index per Hospital Bed, the Time until Removal of Feeding Tube, the Time until Reintroduction of Oral Feeding, and the Time until Decannulation. Conclusion: The panel of indicators proposed promotes the swallowing rehabilitation management at hospital units. The implementation of this tool allows the performance analysis of services over time, after the inclusion of new processes or technologies, and allows comparison to other services considered references in the area. Measuring indicators is essential for quality management. Management through indicators gives evidence to the efficacy and efficiency of swallowing rehabilitation programs.

There is little research studying the relationship between caregiver quality of life and gastrostomy, a palliative intervention recommended to manage dysphagia and malnutrition in patients diagnosed with Amyotrophic Lateral Sclerosis (ALS). To facilitate a more comprehensive assessment of treatment effectiveness and to better guide patients and their families, this study investigated the relationship between gastrostomy, caregiver strain, and patient disease-related factors. Patients with bulbar-onset ALS and their caregivers were recruited regardless of their decision to accept or decline future gastrostomy. Caregivers completed the Modified Caregiver Strain Index (MCSI) to assess levels of caregiver strain as an index of quality of life. Surveys were completed at 3-month intervals prior to gastrostomy and at a single time point following gastrostomy. Of 13 patient-caregiver dyads recruited, 1 dyad completed both phases of the study as of yet. This caregiver reported increased caregiver strain following gastrostomy. Medical interventions aimed at managing dysphagia, such as gastrostomy, may not have a predictable impact on caregiver strain, as indexed by the MCSI, or changes in caregiver strain may reflect characterological differences among patient-caregiver dyads. Other psychosocial factors within a given patient-caregiver dyad may be stronger predictors of caregiver strain, burden, and quality of life in caregivers.

<p><b>Aims</b></p><p>The aims of the thesis were to validate investigation instruments for stroke patients with dysphagia, and to improve oropharyngeal dysphagia therapies.</p><p><b>Methods/Results</b></p><p>A Lip Force Meter, LF 100, affirmed excellent intra- and inter-reliability, sensitivity and specificity. Controls had significantly stronger lip force (LF) and swallowing capacity (SC) than stroke patients. A normal lower limit of LF was set to 15 Newton. Dysphagia symptoms improved in 7 stroke patients after a 5-week sensorimotor stimulation therapy comprising manual body and facial regulation in combination with palatal plate application. Impaired LF and impaired SC were parallel phenomena in 22 acute stroke patients and did not differ regardless of presence or absence of facial palsy. LF and SC improved and were parallel phenomena in 30 stroke patients and did not differ regardless of presence or absence of facial palsy, time lag between stroke attack and start of treatment, or age. SC was normalized in 19 of 30 dysphagia patients after a 5-8-week daily lip muscle self-training with an oral screen. </p><p><b>Conclusions</b></p><p>LF100 is an appropriate and reliable instrument for measuring lip force. Dysphagia improvement, by body and facial sensorimotor stimulation in combination with palatal plate application, or by training with an oral screen is excellent examples of brain plasticity and cortical reorganisation. . Swallowing capacity and lip force in stroke patients are parallel phenomena. A sub clinical facial paresis seems to be present in most stroke patients. Training with an oral screen can improve LF and SC in stroke patients with oropharyngeal dysphagia. </p>

<b>Aims</b> The aims of the thesis were to validate investigation instruments for stroke patients with dysphagia, and to improve oropharyngeal dysphagia therapies. <b>Methods/Results</b> A Lip Force Meter, LF 100, affirmed excellent intra- and inter-reliability, sensitivity and specificity. Controls had significantly stronger lip force (LF) and swallowing capacity (SC) than stroke patients. A normal lower limit of LF was set to 15 Newton. Dysphagia symptoms improved in 7 stroke patients after a 5-week sensorimotor stimulation therapy comprising manual body and facial regulation in combination with palatal plate application. Impaired LF and impaired SC were parallel phenomena in 22 acute stroke patients and did not differ regardless of presence or absence of facial palsy. LF and SC improved and were parallel phenomena in 30 stroke patients and did not differ regardless of presence or absence of facial palsy, time lag between stroke attack and start of treatment, or age. SC was normalized in 19 of 30 dysphagia patients after a 5-8-week daily lip muscle self-training with an oral screen. <b>Conclusions</b> LF100 is an appropriate and reliable instrument for measuring lip force. Dysphagia improvement, by body and facial sensorimotor stimulation in combination with palatal plate application, or by training with an oral screen is excellent examples of brain plasticity and cortical reorganisation. . Swallowing capacity and lip force in stroke patients are parallel phenomena. A sub clinical facial paresis seems to be present in most stroke patients. Training with an oral screen can improve LF and SC in stroke patients with oropharyngeal dysphagia.

Sväljkapacitet kan skilja sig åt mellan olika åldrar och kön. Detta kan inverka på prestationen på så kallade vattensväljtest. Ingen uttömmande studie har gjorts angående effekt av ålder, kön och vattenmängd på sväljförmåga hos friska vuxna i Sverige. Syftet med föreliggande studie var att presentera normdata för tre olika mått på sväljförmåga: sväljtid, sväljkapacitet och antal klunkar vid 1 respektive 2 dl vatten hos friska vuxna, samt att undersöka effekter av vattenmängd och ålder respektive kön på sväljförmågan. 239 vuxna deltagare stratifierades utifrån ålder och kön. Under testförfarandet noterades sväljtid, antal klunkar samt övriga observanda. Resultatet visade signifikant längre sväljtid, lägre sväljkapacitet och fler klunkar såväl hos individer över 70 år som hos kvinnor. Tydligare skillnader kunde ses med den större vattenmängden. Dessutom framkom att 1 dl vatten inte mäter sekventiell sväljning hos samtliga individer. / Swallowing may differ between different age groups and genders. This may affect performance on water swallow tests. So far there have been no comprehensive studies on the effect of age, gender and water volume on the swallowing performance of healthy adults in Sweden. The aim of this study was to present normative data for three different measures of swallowing: swallowing time, swallowing capacity and number of swallows at 100 ml and 200 ml of water in healthy adults, and to examine possible effects on swallowing of age and gender. The 239 adult participants were stratified according to age and gender. During testing, time, number of swallows and a number of deviations were noted. Results showed significantly longer swallowing times, lower swallowing capacity and more swallows both in individuals older than 70 and in women. These differences were greater when using the larger volume of water. Furthermore, results showed that 100 ml of water was insufficient for measuring sequential swallowing in some individuals.